HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making

The burden of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) on the elderly population in three divisions within the Northwest Region of Cameroon was examined. Data for this paper were extracted from a larger study which had been conducted concerning the burden of HIV infection and AIDS on the older adults in the Northwest Region of Cameroon. Using in-depth interviews (IDIs) and focus group discussions (FGDs), data were collected from 36 participants who were purposively selected from the three divisions which had been chosen randomly. 6 FGD sessions were held with 30 women aged 60 years and above and who were affected by HIV infection and AIDS, while IDIs sessions were held with 6 male community leaders. The results revealed that HIV infection and AIDS has added another dimension to the role of older persons. HIV infection and AIDS affects older people in diverse ways, as they have to look after themselves, their sick children and are often also left to look after their grandchildren orphaned by HIV infection and AIDS. These emerging issues in their lives make them vulnerable to health, social, economic and psychological challenges, and place a burden on them as caregivers instead of being cared for in their old age. Apart from increased direct expenditures, taking care of victims of HIV infection and AIDS requires older people to stay away from social, religious and community activities. The results showed that the loss of a child to HIV infection and AIDS affects the economic/financial well-being, participation in social/religious interactions as well as the community activities of older people participants. The implications of these findings for caregiving and social policy are discussed.     

The newest epidemic: a review of HIV/AIDS in Central and Eastern Europe

HIV/AIDS has emerged as a grave public health threat in Central and Eastern Europe and in the Central Asian republics over the past five years. Massive political, social, cultural, and behavioural changes - along with economic upheaval and collapse of the public health infrastructure in many countries - have created circumstances conducive to the rapid spread of HIV. This paper reviews HIV and sexually transmitted disease (STD) data for all countries in the region, as well as behavioural, social, cultural, and other HIV epidemic enabling factors. The epidemiological picture of HIV in the region is mixed. Russia, Ukraine, Moldova and Belarus already have advanced epidemics. Some other countries in the region share similar enabling factors and have seen a very high proportion of their total number of HIV infections detected in only the past 18 months, indicating the emergence of recent epidemics. Several countries are more stable in their HIV incidence. Behavioural studies indicate that risky sexual and injection related practices are common in many vulnerable populations. HIV prevention steps, if taken quickly enough and on a large scale, can limit the scope of the HIV epidemic that is now unfolding in Central and Eastern Europe. This will require new models of government/non-governmental organization cooperation, policy approaches for addressing structural factors underlying the epidemic, and attention to human rights protection.     

The emerging HIV/AIDS epidemic in Georgia

The first case of HIV in Georgia was diagnosed in 1989. Through December 2002, a total of 375 cases of HIV infection were reported. However, the World Health Organization estimates that the true number of infections may be closer to 1700. In all, 70% of reported cases are among injection drug users. Based on the UNAIDS classification, Georgia is a 'low-level HIV country' with an HIV prevalence of less than 1% in all groups, including drug users. However, there is a high prevalence of hepatitis B and C, suggesting a significant risk for the spread of HIV. Georgia, a newly independent republic, is experiencing an increase in injection drug use, a rise in sexually transmitted infections and commercial sex trade that create a fertile soil for the potential rapid spread of HIV. However, it is also a country with a unique window of opportunity for limiting the spread of HIV.     

Changing trends and the impact of alcohol on the HIV/AIDS epidemic in South Africa: Review

The association between increased HIV infection and alcohol use has been extensively studied and is established. South Africa is among one of the sub-Saharan African countries with the highest prevalence and number of people living with HIV/AIDS in the world. Although recent evidence suggests that the epidemic has stabilised, infection rates remain unacceptably high. Alcohol use is on the increase, particularly in the groups most susceptible to HIV infection, namely women and young adults, and informs poor choices with respect to safer sexual practices. This paper reviews the association between alcohol and HIV. More specifically, however, it aims to explore the potential socio-politico-biological and cultural explanations as to the factors that intersect to drive these two epidemic diseases: alcoholism and HIV/AIDS in South Africa. Understanding some of the underlying factors will provide a framework to implement public health measures to curb HIV.     

HIV in central and eastern Europe

We describe recent trends in the HIV epidemic and the differences between eastern and central Europe, using surveillance data, and published and unpublished reports. During the past 5 years, most countries of the former Soviet Union have been severely affected by HIV epidemics that continue to spread as a result of injecting drug use. With an estimated 1 million individuals already infected--mostly injecting drug users--and high rates of syphilis, the region may soon also face a large-scale epidemic of sexually-transmitted HIV infection. Indeed, data indicate that an HIV epidemic, fuelled by heterosexual transmission, is emerging; its expansion will depend on the size of so-called bridge populations that link high-risk groups with the general population. The lack of evidence to indicate increased rates of HIV as a result of homosexual transmission could indicate the social vulnerability of homosexual and bisexual men in the region rather than the true epidemiological picture. In view of the current levels of HIV prevalence, eastern Europe will soon be confronted with a major AIDS epidemic. By contrast, rates of HIV in central Europe remain low at present, but behaviours that promote HIV transmission are present in all countries. Improved measures to prevent further HIV spread are urgently needed.     

The HIV/AIDS epidemic in Cuba: description and tentative explanation of its low HIV prevalence

Background  

The Cuban HIV/AIDS epidemic has the lowest prevalence rate of the Caribbean region. The objective of this paper is to give an overview of the HIV/AIDS epidemic in Cuba and to explore the reasons for this low prevalence.     

HIV and AIDS in Haiti: recent developments

Both the seroprevalence and epidemiology of human immunodeficiency virus (HIV) infection have demonstrated substantial changes in Haiti since the beginning of the epidemic in the early 1980s. Although seroprevalence rates vary greatly according to the population group tested, surveys of healthy urban adults have indicated an increase in HIV infection from about 8% in 1986 to 11% in 1991. The rate in rural areas remains at about 3%. Tuberculosis, herpes zoster, malignant prurigo, and weight loss are the most common signs of HIV infection before the virus progresses to acquired immunodeficiency syndrome (AIDS). The most significant changes in the pattern of HIV transmission in Haiti have been a decline in the proportion of cases among bisexuals/homosexuals (from 50% in 1983 to 1% since 1987) or related to blood transfusion. Also striking has been a change in the geographic distribution of HIV. In 1982, 80% of those infected with HIV were from the capital Port-au-Prince, 10% were from other major cities, and 10% were from other countries. In 1990, only 65% of cases originated from the Port-au-Prince area. Finally, there has been a shift in the sex distribution of HIV, with women contributing 38% of cases in 1989-90 compared to only 15% in 1979-82. Disturbing are survey findings that HIV-infected women, or those with an infected partner, continue to have unprotected sexual intercourse and to take no steps to avoid pregnancy. As a result of the growing number of AIDS cases among women, children under 14 years of age now comprises 6.6% of all AIDS cases compared to 2.4% in 1988. Development of a form of contraception that is as effective against HIV transmission as the condom yet could be used without the consent of the male partner would be an important advance in AIDS prevention in Haiti.     

HIV/AIDS in the Southern USA: A disproportionate epidemic

This research synthesis examined HIV/AIDS surveillance and health care financing data and reviewed relevant research literature to describe HIV epidemiology, outcomes, funding, and contributing factors to the HIV epidemic in the Southern USA with particular focus on a group of Southern states with similar demographic and disease characteristics and comparable HIV epidemics (Alabama, Georgia, Florida, Los Angeles, Mississippi, North Carolina, South Carolina, Tennessee, and Texas). These states are hereafter referred to as “targeted Southern states.” Eight of the 10 states with the highest HIV diagnosis rates in 2011 were in the Southern USA; six were targeted states. Forty-nine percent of HIV diagnoses were in the South in 2011, which contains only 37% of the US population. The targeted states region had the highest HIV diagnosis rate than any other US region in 2011. The South was also found to have the highest HIV-related mortality and morbidity rates in the USA. The high levels of poverty, HIV-related stigma, and STDs found in the South, particularly in the targeted Southern states, likely contribute to greater HIV incidence and mortality. The disproportionate impact of HIV in the South, particularly among targeted states, demonstrates a critical need to improve HIV prevention and care and address factors that contribute to HIV disease in this region.     

山西省HIV/AIDS流行状况分析及防治对策

目的 掌握山西省艾滋病(AIDS)流行状况和特征，明确防治工作重点，为决策者提供科学依据。方法 收集和整理山西省1995～2003年艾滋病病毒(HIV)／AIDS病例报告和个案流行病学调查表，进行统计分析。结果 山西省1995～2003年累计报告HIV／AIDS644例，平均每年以202％的速度增长，其中病人334例，占51.8％(334／644)；死亡152例，占45.5％(152／334)。HIV感染人群以既往有偿供血员为主，因不规范的采供血造成经血液传播的占76.1％(490／644)；主要分布在晋南、晋东南地区，占84.9％(547／644)。男女比例为2.1：1。不安全性行为占6.8％(44／644)，吸毒占2.3％(15／644)，母婴传播3.6％(23／644)，是潜在的危险因素。结论 山西省艾滋病流行快速增长，且已进入发病和死亡高峰，存在多种潜在危险因素。各级领导应提高认识，针对各种危险因素，采取积极的有效措施，控制艾滋病的进一步流行。同时，要开展医疗救治，提高HIV感染者和AIDS病人的生命质量，降低死亡率。     

HIV/AIDS流行控制中的社会性别分析

目的 为了避免艾滋病病毒／艾滋病(HIV／AIDS)预防工作中出现的社会性别盲点，卓有成效地开展各项预防活动。方法 在文献回顾的基础上采用社会性别分析方法，阐明控制HIV／AIDS流行中的社会性别问题。结果 在HIV／AIDS严重流行地区，女性感染者人数超过了男性，由于传统的社会性别分工、社会观念和社会性别不平等，虽然使男女两性均对HIV／AIDS易感，但女性更易感。结论 社会性别平等与否是影响HIV／AIDS流行和控制的因素之一，建议将社会性别视角纳入HIV/AIDS预防控制主流，以提高预防工作的针对性和有效性。